Care Management Program Manager

We are seeking a dynamic individual to manage the development, implementation, and evaluation of care management service lines within our organization. This role is essential in enhancing the quality of member management through the promotion of continuity of care and cost-effectiveness via comprehensive inpatient and outpatient management strategies.

Job Summary

The Care Management Program Manager will ensure effective integration of care, case management, utilization review, and care planning. This position plays a vital role in optimizing member care and enhancing operational efficiency.

Essential Functions

• Collaborate with internal and external physician advisors and relevant departments to establish safeguards, processes, and expected outcomes for the member population.
• Coordinate preventative care, wellness, and nutritional counseling services for members.
• Build and maintain positive relationships with internal and external customers.
• Work alongside physicians, staff, and leadership to focus on quality improvement activities that enhance resource utilization, care delivery, patient flow, and capacity management.
• Continuously assess members’ medical conditions to ensure they meet medical necessity criteria.
• Communicate changes that may impact discharge plans and manage all aspects of discharge planning and utilization management.
• Perform related job duties as assigned.

Qualifications

• Bachelor’s Degree in Nursing (BSN) is preferred.
• Experience in nursing is preferred.
• Certification as a Certified Case Manager (CCM) is preferred.
• Valid Registered Nurse (RN) licensure in the state of practice is required.

Organizational Requirements

Our organization is committed to ensuring the safety and well-being of all associates and patients. Therefore, all associates must receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

We also participate in E-Verify. For more information about the E-Verify process, please visit the E-Verify Participation and Right to Work notices.